I have had ferrets that have had good quality life with insulinoma for
3 to 5 years.  Generally, we wait for a year or so after the initial
diagnosis before doing the first surgery.  We monitor blood glucose levels
at home with a glucometer (like diabetics use) during that time.  Symptoms
usually go into remission for a year or so after surgery.  When symptoms
recur we begin medication and we again wait for months before resorting to
another surgery, IF the ferret is still a good surgical candidate at that
time.
 
(If adrenal tumor symptoms crop up, however, surgery is done immediately,
as long as the ferret is otherwise medically stable.  Insulinoma tumors
are removed during the adrenal surgery.)
 
The reason for waiting before surgery is that often, in the initial stages
of insulinoma, many of the tumors on the pancreas are still microscopic
and can't be seen to be removed.  Even after months of waiting, there can
still be microscopic tumors that will not be removed and will shorten the
length of time that the ferret can go without daily medication.  There's
simply no way to know, and there's no way the vet can tell if they've all
been removed.
 
Insulinoma is not curable, but it IS very manageable.  The number one,
most critical issue is diet.  The ferret MUST eat regularly, and the food
MUST contain a high ANIMAL BASED protein.  My recommendation for this is
kibble & water soup or chicken baby food.
 
(Kibble MUST be high in animal based protein.  I recommend Totally Ferret,
Superior Choice, or Eukanuba Kitten foods.  There are no other ferret or
cat foods that I recommend for insulinoma ferrets... and I've read just
about every label of all the rest on the market.  Other foods may be
adequate for your other ferrets, but with insulinoma, every bite of food
counts.  The SOURCE of the protein percentage is what matters... NOT how
high the number is!  FERRETS CANNOT METABOLIZE VEGETABLE BASED PROTEINS
like corn or soy.)
 
If your vet has prescribed Carafate for your ferret, the vet very likely
suspects the presence of stomach ulcers.  For this ferret, I would feed a
100% diet of chicken baby food, not A/D (A/D is simply the veterinarian
standard "sick critter" food).  Baby food is more easily digested and very
gentle on the stomach and MOST IMPORTANTLY; it is MORE of what a FERRET
needs.  A liquid vitamin could also be added to this.  I would not give
Ferretvite type vitamins due to the sugar content per dosage.
 
Mix warmed chicken baby food with a little water until it's just watery
enough to drop from a dropper.  10ml (or 10cc) every 3 hours is the
absolute minimum amount.  15ml to 20ml is good.  If you can't (or it's too
stressful for the ferret) to get 10ml at once, give 5ml, then wait 10 to
15 minutes and give 5ml more.  ALWAYS feed before leaving for work/school
or bedtime.
 
With a ferret on Carafate, I give the Carafate 15 minutes before feeding
soup.  In some cases I add 1/8th tablet of Zantac crushed in 0.5ml of
water (or pedialyte) 30 minutes BEFORE the Carafate and feeding.  Carafate
must have an acidic stomach to work, so any antacid must be given at least
30 minutes before or after Carafate.  This protocol covers both "upset
stomach" bases and in many cases encourages the ferret to eat more.  As
long as the ferret is on Carafate I would not coax or allow more than 15ml
at a time.  Smaller and more frequent feedings will produce better and
quicker results.  Soup feedings can be reduced to morning and night AFTER
the ferret has returned to normal eating routine of dry food.
 
Ferrets with upset stomachs (low blood sugar symptom) or stomach pain
(stomach ulcer symptom) will not eat voluntarily... especially when you're
not there.  When they don't eat enough animal based protein, blood glucose
levels drop even farther.  A 12-hour fast for these ferrets can induce
seizures that can be fatal or can cause damage to other organs, eventually
causing fatal organ failure.  ALWAYS make sure they don't go longer than 8
hours without a 10ml feeding immediately before and after that 8-hour time
span.  With very weak ferrets, I get up once in the night for a small
feeding.
 
Seizures are to be avoided at all costs.  They are most likely to occur
after a prolonged period of not eating.
 
Should you noticing drooling, stumbling, limpness, twitching, or jerking,
immediately give no more than a teaspoon of watered syrup or honey.  BE
SURE the ferret is swallowing.  Watch for the throat muscles to move
slightly.  If he won't swallow rub undiluted syrup on his gums, smearing
between teeth.  As soon as the ferret looks "almost" normal, give baby
food soup or egg yolk.  It is IMPERATIVE to follow the syrup with the
protein food.  The syrup elevates blood sugar quickly, usually within 10
to 15 minutes, but it will let blood sugar levels "crash" even lower if
the "immediate" sugar (from the syrup) is not replaced with sugar
metabolized from an animal protein food.  As soon as you've given the
protein food, call your vet.
 
Don't waste critical time calling the vet before giving syrup.  Don't
second guess yourself with questions like "Is this really a seizure or
episode?" Better safe than sorry.  A dose of unnecessary sugar won't kill
your ferret... hypoglycemic shock will.
 
Seconds count.  The sooner the hypoglycemic shock episode is stopped, the
less damage is done to the ferret's organs.  THERE'S NOTHING THE VET CAN
TELL YOU THAT WILL HELP MORE THAN THE SYRUP!  You can't get to the vet's
office soon enough to help MORE than giving the syrup.  That's the number
one thing you've GOT to keep telling yourself while you're having a panic
attack.  SYRUP FIRST... everything else will wait.
 
Normally, diet and medication WILL prevent seizures.  Ferrets tolerate
steroids (like Pred) much better than humans.  Don't be afraid to increase
the dosage (no more than 0.25ml increments for a week at a time) if
activity level and appetite is not improving toward normal.  Pred dosage
for insulinoma ferrets is NOT an exact science.  It's far, far better to
give too much than too little.
 
Once good activity, appetite and stable blood glucose levels are attained
for two months, you can try lowering the dosage (again in increments of
no more than 0.25ml for at least a week at a time) to see if activity,
appetite, and glucose levels will remain stable with a lowered dosage.
But FIRST get her stable & stronger with the higher dosage.  Later on
in the progress of the illness and when surgery is no longer a viable
option, it's sometimes necessary to add Proglycem to the pred to maintain
prevention of symptoms and good quality of life.
 
A few more DONT'S specific to insulinoma ferrets ONLY:
 
Don't give Brewer's Yeast or Chromium, or feed foods containing it.
 
Avoid anything with ingredients ending in "ose" (dextrose, lactose, etc.)
"ose" = sugar.
 
Don't overlook "unusually sleepy" behavior.  It's usually an advance sign
of an episode.
 
Feel free to print this out and discuss it with your vet.  Your vet may
want to modify dosage recommendations or issue additional cautions due
to factors that I am not aware of.  This advice is NOT a substitute for
veterinary care.
 
Please see the article on supportive care for help with feeding techniques
and diet care for insulinoma ferrets at
http://www.geocities.com/ferretsfirst/feeding.html
 
Debi Christy
Ferrets First Foster Home
 
Practical & easy training, care, & maintenance articles available at
http://www.geocities.com/ferretsfirst/
[Posted in FML issue 3671]